A Case of Heterotopic Pancreatic Tissue Discovered in the Distal Esophagus

Abstract

Heterotopic pancreas (HP) is a congenital abnormality that represents ectopic pancreatic tissue that does not have anatomic, vascular, or ductal continuity. The prevalence of HP is 0.55% to 13.7% on autopsy, 0.2% to 0.5% of abdominal operations, and 0.9% of gastrectomies. It is commonly found in the stomach, duodenum, and proximal jejunum. Only 15 cases have been reported in the medical literature regarding involvement of the esophagus. Treatment depends on symptoms and location. In asymptomatic patients, simple observation may be sufficient; however, in those who are symptomatic, surgery may be warranted. We present a case of a 70-year-old male with heartburn, nausea, and abdominal bloating who underwent a diagnostic esophagogastroduodenoscopy (EGD) and was found to have HP on histology in the distal esophagus. In our case, symptoms were treated conservatively and successfully with a proton pump inhibitor (PPI).

Malignant transformation of heterotopic pancreas as middle esophagus adenocarcinoma—A rare case report and comprehensive literature review

“…It is more predominant in men than women and typically is not discovered until the fifth to sixth decade of life. Only a few cases are diagnosed in children 5 . There are several theories regarding the development of heterotopic pancreas: (i) the dislocation theory states that during foregut rotation, the original pancreatic components are separated, deposited, and develop ectopically, thus gradually forming mature pancreatic tissue.…”

“…Only three cases of malignant transformations of the heterotopic pancreas at the esophagus have been reported in the literature (Table 2). 3,5,9–23 …”

“…On the left side, a ductal gland was identified with pancreatic intraepithelial neoplasia 1 (PanIN-1) changes next to the carcinomatous glands, which indicates that this adenocarcinoma originated from the pancreatic duct (Â100 magnification) in children. 5 There are several theories regarding the development of heterotopic pancreas: (i) the dislocation theory states that during foregut rotation, the original pancreatic components are separated, deposited, and develop ectopically, thus gradually forming mature pancreatic tissue.…”

“…Only three cases of malignant transformations of the heterotopic pancreas at the esophagus have been reported in the literature (Table 2). 3,5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] There is no standardized guideline for the management of heterotopic pancreas, but treatment depends on the patient's clinical symptoms and the location of the lesion. For asymptomatic patients or those with small lesions, regular observation, or medication is appropriate.…”

“…Only a few cases are diagnosed in children. 5 There are several theories regarding the development of heterotopic pancreas: (i) the dislocation theory states that during foregut rotation, the original pancreatic components are separated, deposited, and develop ectopically, thus gradually forming mature pancreatic tissue. (ii) The metaplasia theory posits that heterotopic pancreas originates from the endoderm of the pancreatic metaplasia region and then migrates to the submucosa during embryogenesis.…”